TITLE:
Intracranial Suppurations in Africa: Systematic Review
AUTHORS:
Léon Boukassa, Olivier Brice Ngackosso, Sinclair Brice Kinata, Hugues Brieux Ekouele Mbaki
KEYWORDS:
Intracranial, Suppuration, Abscess, Empyema
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.10 No.2,
March
18,
2020
ABSTRACT: Background: Intracranial suppurations (ICS) due to common causative microorganisms are still an important health problem in Africa. Their management, which has certainly been improved by technological developments, varies according to neurosurgical teams. Objectives: To describe the clinical characteristics, the causative microorganisms, the outcome, and provide relevant data on the current modalities of the care of ICS. Methods: We conducted a systematic review of studies on intracranial suppurations published in Africa between January 2002 and December 2018. We included studies which had at least 6 patients with ICS. Pubmed, Google and Google scholar were searched for relevant studies. A total of 17 studies were found, from which we define the epidemiological aspects, therapeutic, and evolutionary diagnostics. Results: A total of 1166 patients were identified, and they were categorized as follows: 531 cases of abscess, 272 of empyema and 363 of intracranial suppurations with incomplete data (ICSDI). The average age in ICSDI was 10.9 years. In abscesses and empyema, 75% of patients were under 40 years. There was a male predominance of 2.4 to 1. These intra-cranial suppurations in general complicated mainly loco-regional infections. The classic triad was dominated by headache (66.5%), fever (59.4%) and neurological deficits (46.1%). The CT rarely associated with the MRI, had shown a predominance of supra-tentorial sites (92.5%) of which 37.5% was in frontal region. Of the 380 microorganisms isolated, Gram positive represented 68.9%, Gram negative 17.7% and anaerobic 13.4%. The treatment was medico-surgical (79.5%). It associated a triple antibiotherapy and a trepano-puncture. It had achieved healing in 88.2% of which 20.4% had sequelae. Case fatality rate was 11.8%. Conclusion: ICS constitute during this century, a health problem whose solution passes by the adequate treatment of loco-regional infections, their main sources.